Fentanyl suppression of nociceptive neurons in the superficial dorsal horn of the cat

This study was designed to examine the influence of spinally administered fentanyl on the spontaneous and noxiously evoked activity of high threshold (HT) and wide dynamic range (WDR) neurons in the superficial layers (lamina I and II) of the dorsal horn of cats made decerebrate and in which the spinal cord had been transected. Single unit activity was recorded using extracellular microelectrode recording techniques. Neuronal activity was evoked by the presentation of noxious radiant heat (51 degrees C) to the cells' receptive fields on the hind paws. Evoked activity of WDR neurons was monitored, both before and after the spinal administration of either 10 micrograms (n = 9) or 25 micrograms (n = 10) of fentanyl. HT neurons were examined before and after either 25 micrograms (n = 7) or 50 micrograms (n = 7) of spinally administered fentanyl. In all cases 31 min after fentanyl administration naloxone (0.1 mg) was administered intravenously (iv), and its antagonistic effect on the fentanyl suppression was determined. All doses of fentanyl tested suppressed both spontaneous and evoked activity of both types of neurons. Within 30 minutes 10 and 25 micrograms of fentanyl reduced the mean evoked activity of WDR neurons to 61% and 19% of control values, respectively, and 25 and 50 micrograms of fentanyl reduced the mean evoked activity of HT neurons to 70% and 47% of control values, respectively. Naloxone reversed the suppression seen in all cells studied. The results of the present study demonstrate that HT neurons are significantly less suppressed by the spinal administration of fentanyl than WDR neurons located in the same superficial layers of the dorsal horn.(ABSTRACT TRUNCATED AT 250 WORDS)

Deficiency of cardiac beta-adrenergic receptor in streptozocin-induced diabetic rats

The number of beta-adrenergic receptors in cardiac myocytes isolated from rats made diabetic with streptozocin (STZ) for 10 wk was measured by use of a hydrophilic nonselective antagonist [3H]CGP 12177 and was found to decrease to 59% of the number in control rats (P less than .05), without any change in affinity. Similarly, using [125I]iodocyanopindolol as a ligand, we found a decrease in the beta-adrenergic-receptor number on cardiac plasma membrane isolated from the diabetic rats [29% decrease (P less than .05) at 1 wk, 50% (P less than .01) at 3 wk, and 49% (P less than .01) at 10 wk compared with control rats]. However, the serum triiodothyronine level that had been known to modulate the beta-adrenergic-receptor-adenylate cyclase system was decreased in the 1-wk-diabetic rats but not in the 10-wk-diabetic rats compared with each control group. Furthermore, there was no difference in urinary catecholamine excretion between diabetic and control groups. In the 10-wk-diabetic rats, the response of adenylate cyclase to isoproterenol was significantly defective (56% decrease compared with control rats; P less than .05), although both the basal and the forskolin-stimulated maximum adenylate cyclase activities and a half-maximum concentration of isoproterenol for the stimulation of adenylate cyclase were similar in control and diabetic rats. On the other hand, both cholera toxin-dependent and islet-activating protein-dependent [32P]NAD incorporations into cardiac plasma membrane were markedly increased in the diabetic rats.(ABSTRACT TRUNCATED AT 250 WORDS)

[Four cases of upper urinary tract transitional cell carcinoma after radical cystectomy in bladder cancer]

One hundred and eighty-six patients with primary transitional cell carcinoma underwent radical cystectomy between 1965 to December, 1986. Four of them (2.2%) had developed upper urinary tract transitional cell carcinoma. Three of the 4 patients had received various transurethral treatments for the primary bladder lesions before radical cystectomy, but one patient had undergone total cystectomy and ileal conduit as primary treatment. All of the upper urinary tract tumors were invasive. Three patients died and one is alive. We consider the following to be high risk patients for the development of upper tract recurrence. 1) patients with carcinoma-in-situ and multicentric tumors in the bladder, 2) patients with recurrent bladder cancer treated with bladder preserving treatment for a long periods, 3) patients with vesicoureteral reflux, and 4) occupational bladder cancer patients.

[Experience with combination chemotherapy consisting of methotrexate, vinblastine, adriamycin and cisplatin (M-VAC) in advanced urothelial cancer]

The M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) regimen was used to treat 6 patients with metastatic transitional cell carcinoma of the urothelial tract. Three patients showed a partial response, all of them were made surgically disease free. Two of them are still alive 1 year and for 6 months after surgery with no evidence of disease and one other died of disease 11 months after surgery. The response in one case was no change and that in two others was a progressive disease. From our experience, we suggest that treatment with M-VAC is effective but that surgery after M-VAC appears essential for the successful management of the patients with metastatic transitional cell carcinoma of the urothelial tract.

[Clinical study on the effect of CSF-HU (colony stimulating factor human urine) on leukopenia and granulocytopenia induced by cancer chemotherapy--a double-blind study in patients with genito-urinary cancer]

The ability of CSF-HU (P-100) to inhibit and improve the leukocytopenia and granulocytopenia which occur following cancer chemotherapy was investigated in a double-blind study which included an inactive placebo. The drug was administered, 2 vials/day (8 X 10(6)U of P-100), by intravenous drip infusion consecutively for 7 days starting from the 5th day after cancer chemotherapy was initiated. The total cases included in the study numbered 261. The efficacy rate was 53.0% for the P-100 group and 38.9% for the placebo group, while the usefulness rate was 54.8% for the former and 38.1% for the latter. In either case, statistically significant differences were observed in favor of the P-100 group. The reduction in the number of days before the leukocyte count returned to 4,000/mm3 was statistically significant in the P-100 group. While side effects appeared in both the P-100 (4.8%) and the placebo (4.4%) groups, none of them were considered to be serious. Judging from these results, p-100 was considered to be a useful therapeutic drug for the treatment of leukocytopenia and granulocytopenia following cancer chemotherapy.

[Complete remission of stage III penile cancer by multidisciplinary treatment: report of a case]

A case of penile cancer with bilateral metastatic inguinal lymph nodes in a 68-year-old male is reported. We used combination chemotherapy with methotrexate, bleomycin, and cisplatin for 2 courses before ilioinguinal lymphadenectomy. The surgical specimen of ilioinguinal lymph nodes revealed no viable tumors. It is clear that this combination therapy was effective against metastatic penile cancer and the role of preoperative chemotherapy is becoming increasingly important in metastatic penile cancer. This chemotherapy and surgical approach deserves additional trial in patients with metastatic penile cancer.

Red-cell-volume distribution curves in diagnosis of glomerular and non-glomerular haematuria

The distribution curves of urinary red-blood-cell (RBC) size were obtained from automated blood-cell analysis in 146 patients with definite causes of haematuria. In 65 of 67 patients (97%) with haematuria and glomerulonephritis demonstrated by renal biopsy, urinary RBC had an irregular and asymmetrical distribution with RBC size showing a much smaller volume than that of venous RBC. This "glomerular" distribution contrasted with the "non-glomerular" normal distribution when the peak for RBC was at a larger volume than that for peripheral RBC. In 46 of 47 patients with haematuria who had lower urinary tract lesions other than infection, a non-glomerular distribution was obtained; 30 of these cases also showed glomerular distribution, and were classified as "mixed". All 32 patients with urinary tract infection had either a glomerular or mixed distribution, suggesting that they excreted distorted and dysmorphic urinary RBC. After excluding infections, this simple, rapid, reproducible, and non-invasive technique provides reliable information in distinguishing glomerular bleeding from other causes of haematuria.

[Genital Paget's disease with general metastasis: a case report]

A 74-year-old man with the chief complaint of ulceration of penile shaft and scrotal swelling was referred to our hospital on November 7, 1985. Biopsy specimen of the local lesion histologically revealed invasive adenocarcinoma with Paget's cell. Clinical studies revealed a high serum carcinoembryonic antigen (CEA) level and regional lymph node metastasis was highly suspected. We concluded that the patient was suffering from Stage II genital Paget's disease. Emasculation, bil-inguinal and pelvic lymph node dissection, and free skin mesh grafting were performed on December 24, 1985. Histological findings of the tumor confirmed Paget's disease and bil-inguinal and pelvic lymph node metastases. CEA staining showed CEA positive malignant cells in both the primary lesion and metastatic lymph nodes. After operation, the rapid deterioration of the patient's condition was accompanied by extremely high serum CEA levels, obstructive jaundice, and evidence of metastasis to the liver. He died 24 days after operation and autopsy could not be performed. We recommend aggressive treatment when clinical studies reveal invasion to the epidermis, high serum CEA levels and lymph node metastasis.

[A case of paraureteral neurilemmoma causing ureteral obstruction: report of a case]

Retroperitoneal neurilemmomas are rare tumors. They are usually asymptomatic, and often become quite large before they are discovered. A case is reported of a 75-year-old man with complaints of general malaise and left lumbar pain. Intravenous pyelography showed left renal nonfunctional and retrograde pyelography revealed the stenosis of the left ureter. The ultrasonogram demonstrated a cystic mass, and it was diagnosed as a retroperitoneal tumor with central necrosis by computerized tomography and magnetic resonance imaging. The tumor was removed with the left nonfunctioning kidney and ureter. The tumor was 3 x 3 x 4 cm, and the histological diagnosis was neurilemmoma (Antoni A + B type). There was a tight fibrous adhesion between the tumor and the left ureter, and the tumor was concluded to have originated from the adventitia of ureter. To date, 120 benign cases have been reported in Japan. They are reviewed and discussed.

[Recent management of renal cell carcinoma]

Our experience of radical nephrectomy was analyzed and recent management of renal cell carcinoma was reviewed. One hundred forty-eight patients with renal cell carcinoma were treated by radical nephrectomy between 1970 and December, 1986. The 5-year survival rate according to pathological T-stage was 100% for 4 patients in pT1, 73% for 85 patients in pT2, 51% for 54 patients in pT3, and 0% for 5 patients in pT4. Four patients in pT1 had no venous involvement, lymph node metastasis, or distant metastasis. Thirty patients had venous involvement, 8 in pT2, 20 in pT3 and 2 in pT4. Seventeen patients had positive lymph nodes, 0 in pT2, 15 in pT3 and 2 in pT4. Thirty-three patients had distant metastasis at the time of nephrectomy, 12 in pT2, 18 in pT3 and 3 in pT4. The 5-year survival rates of 30 patients with venous involvement, 17 with lymph node metastasis and 33 with distant metastasis were 47%, 30% and 37%, respectively. No anti-cancer drugs have been recognized to be effective for renal cell carcinoma. However, recent experiences with interferon and lymphokine-activated killer cell therapy suggest that immunotherapy may have a potential role in the management of metastatic renal cell carcinoma.

[Hypomagnesemia following chemotherapy of disseminated testicular tumors]

Sixteen patients with metastatic testicular cancer were treated with combination chemotherapy including cisplatin (CDDP) at 3- to 4-week intervals for two to five courses. There was a sequential fall in serum magnesium with each course of therapy: 13 of the 16 patients (81%) became hypomagnesemic, and the median magnesium nadir was 1.67 mg/dl. Serum magnesium nadir levels gradually decreased according to the cumulative CDDP dose. Acute clinical effects of the hypomagnesemia were observed in 4 patients, 2 of them complained of neuromuscular disturbance in the extremities, one of cardiac arrhythmia, and the other of Raynaud's phenomenon. The median time to the onset of hypomagnesemia was 67 days and the duration of hypomagnesemia was 24 days. The creatinine clearance (Ccr) decreased gradually according to the cumulative CDDP dose, and the mean Ccr declined from 87.2 ml/min before therapy to 55.8 ml/min. In 3 out of 16 patients, an irreversible decrease to below 50 ml/min was seen after chemotherapy. In patients with normal renal function treated by VAB-6 regimen, creatinine clearance (Ccr) decreased transiently during each course of chemotherapy and returned to the pretreatment level during the interval. The mean creatinine clearance declined from 90.7 ml/min before therapy to 82.9 ml/min after three courses of induction chemotherapy. Urinary excretion of beta 2 microglobulin (beta 2MG) increased transiently before Ccr began to decrease during each course of chemotherapy. Serum potassium and calcium concentrations decreased transiently probably due to urinary losses but there was no significant relationship between hypopotassemia, hypocalcemia and hypomagnesemia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transurethral ureterolithotripsy using a rigid ureteroscope]

Eighty patients with ureteral stones underwent transurethral ureterolithotripsy using a rigid ureteroscope. In 68 of the patients (85%), the stones were removed successfully. Most of the 12 failures were removed by a percutaneous approach. The main complications of transurethral ureterolithotripsy were high fever (35%), ureteral injury (10%) and ureteral stricture (1.6%). Ureteroscopic procedures are thought to be useful in stone removal and diagnostic evaluation of abnormality of upper urinary tract.

[Penile implantation surgery for organic impotence due to radical cystectomy or prostatectomy]

Implantation surgery was performed twelve times in eleven patients with organic impotence, mainly due to radical cystectomy and prostatectomy against malignancy, between March, 1982 and April, 1987. A self-contained type prosthesis (AMS Hydroflex(TM] was used in 7 cases, reservoir type inflatable prosthesis (AMS 700TM) in 2, malleable semirigid type (ESKA-Jonas Silicon Silver(TM) Trimming Tip Version) in 2, and nonmalleable semirigid type (Fuji system Finney type) in 1 case. In the last case, the prosthesis was replaced by AMS Hydroflex 4.5 years later at patient's wish. Excellent results and good patients' acceptance were gained with inflatable-type prosthesis (AMS 700 and Hydroflex) in 7 out of 8 cases (88%), whereas concealment problems were produced by semirigid type prosthesis (Finney and Jonas). Experience with AMS Hydroflex penile implantation is reported for the first time in the Japanese literature. Intraoperatively, it was sometimes difficult to implant a pair of Hydroflex rods into both of the corpus cavernosum. Postoperative perineal pain was almost constantly seen and in one patient, penile edema continued for three weeks and subsided spontaneously in two months. In another patient, the length of the prosthesis (15 cm) was short, and exchange to the longer one (17 cm) was necessary. In this patient, the longer Hydroflex caused erosion of the glans to necessitate its removal on one side. From our experience, the diameter (11 mm) of the Hydroflex seems to be too big for the average Japanese patient. The operative procedures and results of each kind of the prostheses are briefly discussed.

[Results of radical nephrectomy for renal cell carcinoma. Report 1. Analysis according to the TNM staging system of the general rule for clinical and pathological studies on renal cell carcinoma]

One hundred and six patients with renal cell carcinoma were treated with radical nephrectomy at our Department between 1970 to December, 1985. A retrospective analysis was performed with TNM staging system of The General Rule for Clinical and Pathological Studies on Renal Cell Carcinoma, which was established by the Japanese Urological Association in 1983. The 5-year survival rate according to pathological T-stage was 100% for 2 patients in pT1, 67.5% for 58 patients in pT2, 49.5% for 42 patients in pT3, 0% for 4 patients in pT4. Two patients in stage of pT1 had no venous involvement, lymph node metastasis, or distant metastasis. Twenty two patients had positive venous involvement (21%), 4 (7%) in stage of pT2, 16 (38%) in pT3, 2 (50%) in pT4. Twelve patients had positive lymph nodes (11%), 0 (0%) in stage of pT2, 10 (24%) in pT3, 2 (50%) in pT4. Twenty five patients, (24%) had distant metastasis at the time of nephrectomy, 8 (14%) in stage of pT2, 15 (38%) in pT3, 2 (50%) in pT4. The 5-year survival of 22 patients with venous involvement, 12 patients with lymph nodes metastasis, 25 patients with distant metastasis were 47%, 30%, 39% respectively. No significant difference of 5-year survival between 69% of 48 patients in T1 & 2VoNoMo (Robson-I) and 76% of 12 patients in T3VoNoMo (Robson-II) were considered to need the establishment of new classification for early stage of renal cell carcinoma. TNM staging system was thought to be better than Robson's Classification for analyzing the unique biological potential of renal cell carcinoma.

[Clinical studies with a new non-ionic contrast medium (iopamidol) in intravenous pyelography in aged patients]

Iopamidol (IOPAMIRON 300) was examined for excretory urography on 21 patients, between 70 and 94 years old, with reference to visualization, safety and urinary excretion. The results about visualization and safety were compared with those obtained with 60% Urografin. Iopamidol was demonstrated visualization nearly equivalent to that with Urografin, and 19% better pyelogram. Especially, calix showed a clearer contrast than those obtained with Urografin. None of the 21 old patients experienced any side effects or adverse reactions. No abnormalities were noted in serum chemistries. Iopamidol was not quickly excreted into the urine, only 19% during the first 2 hours, in elder patients.

[Leiomyosarcoma of the prostate: a case report]

A 39-year-old man with the chief complaints of gross hematuria and dysuria was referred to our hospital on June 6th, 1985. Physical examination revealed a tumor in the left lobe of the prostate. Prostatic needle biopsy showed the histological evidence of leiomyosarcoma. Pelvic exenteration with pelvic lymph adenectomy was performed on June 18th, 1985. Histological findings of the tumor revealed leiomyosarcoma and no lymph nodes metastasis. Two courses of vincristine-adriamycin-cyclophosphamide chemotherapy were given postoperatively after a clonogenic assay was done. He considerably improved and was discharged 3 months after operation. He shows no recurrence of tumor 17 months after operation. Thirty-three cases of leiomyosarcoma reported in Japan are reviewed.

[VAB-6 combination chemotherapy in patients with stage II, III testicular tumor]

Between 1983 and 1985, six patients with advanced testicular cancer were treated with 3 cycles of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cisplatinum (VAB-6 combination chemotherapy without maintenance). The histology of the primary tumor was seminoma in one patient and nonseminomatous germ cell testicular tumor (NSGCTT) in 5. Five men with stage III or bulky stage II diseases received no prior chemotherapy but one had received another chemotherapy without cisplatinum. Two patients showed a complete response to chemotherapy. Three were partial responders free of disease after a debulking operation and additional chemotherapy. The other patient who had NSGCTT had recurrence 5 months after the last induction chemotherapy and received additional chemotherapy (PVeBV regimen). Median follow-up was 16 months (range 2 to 28 months) and all patients are alive with no evidence of disease. Severe myelosuppression and serious renal toxicity were not experienced. Marked, but transient elevation of serum transaminase were observed in all patients. These data suggest that this protocol is highly effective and minimally toxic in the treatment of disseminated testicular tumor.

New alpha 2-adrenergic blocker (DG-5128) improves insulin secretion and in vivo glucose disposal in NIDDM patients

Effects of oral administration of DG-5128, a new oral hypoglycemic agent, on glycemic control after a mixed meal and an in vivo glucose disposal were measured in subjects with nonobese non-insulin-dependent diabetes mellitus (NIDDM). Oral administration of DG-5128 significantly (P less than .05) enhanced insulin secretion both 30 and 60 min after a mixed meal (550 kcal), with a concomitant decrease in postprandial plasma glucose levels at 60 and 120 min. Glucose disposal rate between the 2nd and 4th h of a euglycemic insulin clamp, developed through a constant infusion of insulin (0.77 mU X kg-1 X min-1) together with somatostatin (80 ng X kg-1 X min-1), was 2.5-fold higher in a DG-5128-treated group (P less than .01) than in a control group. However, there was no difference between the two groups in either plasma glucose concentration or plasma insulin concentration at either the 2nd or the 4th h. These results indicate that DG-5128 is effective in controlling plasma glucose levels in subjects with NIDDM by stimulation of both insulin secretion and in vivo glucose disposal.

Sequential changes of mouse bladder epithelium during induction of invasive carcinomas by N-butyl-N-(4-hydroxybutyl)nitrosamine

Invasive carcinoma of the bladder in humans shows aggressive growth with poor prognosis. Little is known about its preceding lesions. Sequential changes of the bladder epithelium following administration of N-butyl-N-(4-hydroxybutyl)nitrosamine (BHBN) were studied in mice. Female C3H/He mice were divided into 4 groups. Three groups were given 0.05, 0.01, and 0.005% concentrations of BHBN, respectively, in their drinking water, and the control group was given tap water. The mice were killed at regular intervals over a period of 26 weeks, and their bladder epithelium was examined histologically. Dysplasia, carcinoma in situ, and invasive carcinoma were observed sequentially in the groups treated with BHBN, and the incidences of dysplasia, carcinoma in situ, and invasive carcinoma were dependent on the dose of BHBN. The data indicate that bladder carcinoma in mice is a good model of invasive bladder carcinoma in humans, although it is not fully compatible with the human model because of the complete absence of metastases.

L-isoleucine and L-leucine: tumor promoters of bladder cancer in rats

A 4-week assay for screening tumor promoters of bladder cancer has been developed in which increased agglutinability of isolated rat bladder cells with concanavalin A is used as an indicator. On the basis of this assay system, L-isoleucine and L-leucine were suspected of being possible tumor promoters. Results of 40- to 60-week carcinogenesis experiments in which N-butyl-N-(4-hydroxybutyl)nitrosamine was used as an initiator demonstrate that L-isoleucine and L-leucine promote bladder cancer in rats. This finding may be relevant to the high incidence of human bladder cancer in Western countries, where the diet is rich in protein.

[Changing modality of the treatment in upper urinary tract calculi. Percutaneous nephrolithotripsy and transurethro-ureteral lithotripsy]

From March, 1984 to April, 1985, 70 cases of upper urinary tract calculi (73 renal units) were treated by percutaneous nephrolithotripsy or transurethro-ureteral lithotripsy, mainly utilizing ultrasonic lithotrite. While in the early period of treatment, two stage procedure of creation of nephrostomy tract and percutaneous nephrolithotripsy was performed for renal and upper or middle part of the ureteral calculi, one stage procedure, nephrostomy tract formation followed by ultrasonic nephrolithotripsy is commonly used in recent cases. During this period, conventional stone surgery was seen in 6 cases of pyelolithotomy and 2 of ureterolithotomy, while 52 cases of stone surgery were performed during the earlier period (from January, 1983 to February, 1984). Renal and upper or middle part of ureteral calculi were successfully removed in 49 out of 58 cases (84.5%). Most of the patients required 1 or 2 trials of percutaneous nephrolithotripsy. Middle or lower part of ureteral calculi were removed in transurethro-ureteral approach in 11 of the 12 cases. Hematuria and fever were most common complications after treatment and 3 patients required blood transfusion after 3 or 4 sessions of nephrolithotripsy. Percutaneous nephrolithotripsy and transurethro-ureteral lithotripsy are now widely used for treatment of upper urinary tract calculi, replacing the conventional surgical treatment. Moreover, very recently, extracorporeal shock wave lithotripsy is available in Japan. To the patients with renal calculi indicative of this treatment, both percutaneous nephrolithotripsy and extracorporeal shock wave lithotripsy are introduced and either way of treatment can be chosen by the patient himself.

Correlation of results of agglutination assays with concanavalin A and carcinogenesis experiments on promoters of bladder cancer

The promoting effects of various chemicals and dietary constituents on bladder carcinogenesis were examined by means of a short-term assay, in which maintenance of concanavalin A agglutination of isolated rat bladder cells caused by a subcarcinogenic dose of N-butyl-N-(4-hydroxybutyl)nitrosamine was used as an indicator. Twenty-seven chemicals were examined as possible promoters. Positive results in this assay were consistent with established promoting effects in the cases of sodium saccharin, saccharin, sodium L-ascorbate, sodium cyclamate, DL-tryptophan, butylated hydroxyanisole, butylated hydroxytoluene, L-thioproline and phenacetin. Allopurinol was the only established promoter that gave negative results in the agglutination assay. Thus, this method is useful for rapid evaluation of the specific promoting effect of a chemical on bladder carcinogenesis.

Significance of carcinoma in situ and dysplasia in association with bladder cancer

Cystectomy specimens of 118 transitional cell carcinomas of the bladder were analyzed by step-sectioning. The carcinoma in situ and dysplasia adjacent to and remote from the visible bladder cancer were correlated with the tumor configuration on cystoscopy, and grade and stage of the disease. Results showed that a combination of papillary and nodular carcinomas in a single bladder was associated with a high incidence of mucosal involvement. Moreover, more than 50 per cent of all grade 3 carcinomas were associated with carcinoma in situ and dysplasia adjacent to and remote from the visible tumors. Carcinoma in situ and dysplasia were not related to the stage of disease. For management of bladder cancer, it appears important to assess the gross configuration of tumors by cystophotography and to determine the grade of tumors by biopsy, because mucosal involvement was found to be correlated closely with the tumor configuration and grade 3 disease.

[Undifferentiated carcinoma of the thyroid gland with osteoclast-like giant cells--a case report]

A case of undifferentiated carcinoma of the thyroid gland with osteoclast-like giant cells resembling those of a giant cell tumor of the bone is presented. A 79-year-old female had noticed swelling on the left frontal neck. Histological examination of frontal-neck tumor revealed undifferentiated carcinoma of the thyroid gland. The patient was treated with a Cobalt 60 unit and received a total tumor dose of 2800 rad. However, because of a rapid increase in size of the tumor and its metastasis, the patient died about 2 months after admission. An autopsy was performed. Histologically, the tumor differed from the usual undifferentiated carcinoma of the giant cell type in having osteoclast-like giant cells with many small, uniform, benign appearing nuclei. It is proposed that the osteoclast-like giant cell is reactive rather than neoplastic in nature because of the benign appearance, phagocytotic activity and some ultrastructural features.

Chemotherapy by bronchial arterial infusion for pulmonary metastases of renal cell carcinoma

Bilateral multiple pulmonary metastases of renal cell carcinoma were treated by repeated bronchial arterial infusion of chemotherapeutic drugs, such as mitomycin C, carboquone, doxorubicin and nitrosourea. Of 12 patients treated 2 had a complete response, 3 had a partial response, 2 had no change and 5 had progression of the disease. The over-all response rate was 42 per cent. Since metastatic renal cell carcinoma is unresponsive to ordinary treatment bronchial arterial infusion alone or in combination with an operation appears promising.

Analysis of 90 step-sectioned cystectomized specimens of bladder cancer

For systematic understanding of papillary superficial carcinoma and nonpapillary invasive carcinoma of the bladder 90 cystectomized specimens of transitional cell carcinoma of the bladder were analyzed by step-section. From gross and microscopic observations bladder cancer was classified into 3 types: type 1--multiple papillary superficial carcinomas with or without small areas of dysplasia or carcinoma in situ, type 2--multiple coexistent papillary and nonpapillary carcinomas with widespread dysplasia and carcinoma in situ, and type 3--solitary nonpapillary invasive carcinoma without dysplasia and carcinoma in situ. Actuarial 5-year survival rates for types 1 to 3 were 97, 50 and 17 per cent, respectively. Although this classification is somewhat overlapping and there is a bias that basic data are obtained from the cystectomized specimens, we believe that such an analysis is necessary for considering the histogenesis and progression of human bladder cancer.

Adenocarcinoma of urachus. Report of 7 cases and review of literature

Seven cases of adenocarcinoma of the urachus treated at the National Cancer Center Hospital, Tokyo, over a nineteen-year period are reported. One hundred fifty-five cases reported in English literature and 140 cases in Japanese literature were analyzed with respect to the modalities of treatment, mean remission times, and sites of recurrence or metastases. From this review and experience on the 7 cases reported here, extended radical total cystectomy with well-designed radio- and chemotherapy was proposed for the treatment of this disease.

Radiation therapy for prostatic cancer

From 1962 to 1980, 124 patients were hospitalized for treatment of prostatic cancer. Of these, a total of 115 underwent radiation therapy. Thirty-five patients were classified as stages I and II, 12 as stage III, and 77 as stage IV. The five-year survival rate for patients in stages I and II was 72% in the radiation therapy group and 33% in the nonradiation therapy group. In stages III and IV, there was no difference in survival rate between the radiation and nonradiation therapy groups. Histological examination of prostate tissues of patients treated by radiation therapy revealed various degrees of change in the cancer cells, ranging from degeneration to disappearance. The degree of change was not related to the stage of the disease. Also, no histological differences in prostate specimens from patients who received 4,000-5,000 rads versus 5,000-6,000 rads was observed. Rectal examination indicated that radiation therapy was effective in 93% of the patients in stages I and II, 75% in the stage III, and 71% in the stage IV. The rates of reactivation were 28% for stages I and II, 12% for stage III, and 43% for stage IV.